Provider Demographics
NPI:1518455484
Name:PONQUINETTE, SCOTT M (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:PONQUINETTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 TURNBERRY BLVD UNIT 14479
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-0219
Mailing Address - Country:US
Mailing Address - Phone:888-902-2696
Mailing Address - Fax:
Practice Address - Street 1:2 BEAVER CASTLE COURT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:888-902-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557452111N00000X
VA1518455484204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No111N00000XChiropractic ProvidersChiropractor